knee surgery

[NadiaMac]

I smashed my kneecap into rocks in a bad fall about three months ago --I fell into a ravine while mt biking and most of the impact went to my knee and lower leg. MRI shows cartilage damage ("patellofemoral syndrome" is my Dx), but no damage to major ligaments, tendons, meniscus.

After about 2 months of PT and a cortisone shot, I still suffer significant pain and swelling, even with very restricted physical activity. Worst of all, I am still off my bike. I'm going nuts with the reduced activity, even though I've added swimming to get some cardio. I really, really, really miss the riding.

Since I've kind of plateaued in my recovery, my orthopedist suggests exploratory arthroscopy to "clean things up" (eg, remove any debris, smooth cartilage if necessary) and look for any damage not visible on the MRI.

Anyone have any experience with this type of procedure? How long did it take to recover and how impaired were you after the surgery (crutches?). I'm thinking hard about having the procedure, and would love to hear any anecdotes/info/advice.

[skinimini]

So sorry you're having such issues! :( As someone who has had a lifetime of knee injuries and many surgeries, I am in total sympathy with you. I've had reconstructions, ACL tears, medial and lateral meniscus tears, and arthroscopic surgery just to clean up the joint. As with you, my issues stem from patellofemoral syndrome (and too much running and tennis when I was young). My issues have gotten considerably better in the past 15 months from a combination of losing a lot of weight and working out 3x per week with a good trainer--but it's been a long slow road. For me, I think that increasing core strength, as well as strengthening quads and hamstrings, getting a good balance has made all the difference. I still get a fair amount of swelling after a long ride, but no significant pain anymore. I also worked long and hard on getting cleat position correct--9% float on one and 4.5% on the other.

The surgery is not bad, but I don't think it's a magical fix. For me, it took longer to recover than the orthopedists said. Each time (5x arthroscopically, both knees), it took a couple of weeks on crutches--not the 3-4 days they said. However, I wasn't in the best shape physically those last couple of times. If you're physically fit otherwise, it might be less time.

I would say if you're still having that much pain after a couple of months of PT and restricted activity, then the arthroscopy might be something to consider. Talk long and hard with your Dr. Disclaimer--I'm not a physician or a physical therapist, just someone with similar issues and experience with that type of surgery.

I hope all goes well. Good luck!

[NadiaMac]

Thanks for the info! Wow, 5 surgeries-- glad to hear that you are finally recovering. I was in reasonable condition prior to the accident, but have withered away quite a bit since then due to pain and inactivity. I'm rebuilding strength through PT and hope that this will prepare me for a smooth recovery if I get the arthroscopy.

[KnottedYet]

Knees are very cool things, and they have some very cool ways of "resetting" and repairing themselves. If you are not looking forward to surgery and are unsure about it, and willing to try another approach with PT, may I suggest you find a certified Mechanical Diagnosis and Therapy PT (aka "McKenzie").

A certified MDT therapist would know within 3 visits if your knee was capable of repairing itself using its own "direction of preference." (that's the direction of movement and amount of overpressure that allows the unhappy bits to go back to where they belong or clear out of the weightbearing surfaces so that the body can fix it)

MDT/McKenzie therapists give you one exercise to do, about 10 times every couple hours. Your exercise is the movement your body needs to fix itself, the therapist just helps you find it and monitors you. It's pretty simple and straightforward stuff, we really just stand back and let the body fix itself.

If your knee is irreducible, meaning too damaged for your own movements to help, you and your PT will know within 3 visits. He or she will explain the options at that point. Surgery is certainly on the table, and the information the therapist gets from observing the function and response of your knee will be useful for the surgeon, even if therapy doesn't help your knee fix itself.

McKenzie is more well known for spinal work, less well known for extremities. I've used the problem solving technique on my own knee, and I'm very happy with the results.

Disclaimer: I am a clinician, I do work in a MDT physical therapy clinic, I teach people to fix themselves. They are the cure, not me. I've seen better, faster results with MDT than with any other therapy approach I've used. I've also seen quicker and clearer decisions to refer back to the surgeon when a patient's injury is clearly not appropriate for PT. (less wasted time and less suffering for the patient) I have a bias, and I proclaim it.

If an MDT certified therapist tells you that you are best served by getting surgery, then I'd say get surgery. You can search for certified therapists on this page: http://www.mckenziemdt.org/index_us.cfm
(and if you do, make sure wherever your insurance lets you go that you get a certified or diplomate therapist, not someone who just says "yeah, I know McKenzie" or who has just taken a couple classes)

[NadiaMac]

Thanks everyone! The doc wanted to do another cortisone shot plus 4 more weeks of PT since I responded decently to my last shot. So, this is the plan.

[carolp]

I've had six arthroscopies-- three on each knee, a broken knee cap, and now, one replacement.
I was on crutches for only a day or two after the arthroscopies, but I got my quads really strong before surgery. What led me ultimately to replacement was the broken kneecap. The pain was unbearable and now I do the SF to LA AIDS ride every year.

Other than the orthopod you are seeing, if he isn't strictly a sports med guy, I recommend you see one. My first orthopaedist thought all women did was shop, but then I found someone who really understood my need to be active.

[NadiaMac]

Thanks for the input. My ortho is a sports medicine specialist at SOAR in Redwood City and I like him pretty well so far. He appears to appreciate my desire to get active asap. Unfortunately, my activity level is still capped by soreness in the knee. The cortisone shot has kicked in and is definitely helping in this regard, but I still am maxing out at about 50 mins of no-impact indoor activity (spinning cycle and elliptical). I'm swimming to try and maintain my cardio fitness, but I know my endurance is completely shot.

[Biciclista]

Knees are very cool things, and they have some very cool ways of "resetting" and repairing themselves. If you are not looking forward to surgery and are unsure about it, and willing to try another approach with PT, may I suggest you find a certified Mechanical Diagnosis and Therapy PT (aka "McKenzie").

If an MDT certified therapist tells you that you are best served by getting surgery, then I'd say get surgery. You can search for certified therapists on this page: http://www.mckenziemdt.org/index_us.cfm
(and if you do, make sure wherever your insurance lets you go that you get a certified or diplomate therapist, not someone who just says "yeah, I know McKenzie" or who has just taken a couple classes)

wow, Knot, you are such an asset to this forum!!

Original Poster, i wanted to say, my DH had arthroscopic knee surgery (two knees, two different times) and it is the least invasive surgery i have ever seen. He walked out (with his knee in a brace/soft cast) with two bandaides on his knee.
But with every surgery, you will less when you are done than when you started; and there is recovery time. If you can do these exercises that Knot talks about and improve, boy, that's a huge gain!